Sunday, October 7, 2018

Is it the last time?

At a family event over the summer, my nephew Alex, 14, sat down in his mom’s lap. He stayed there for just a minute, looking like a stretched-out toddler version of himself, with his long, skinny legs overlapping his mom’s, touching the floor.  He smiled, gave her a quick hug, and ran off to hang with his cousins. And watching the moment, I wondered if I was a witness to the final time of lap-sitting for a boy and his mom.
            When my children were young, all the “firsts” were so important. From first bites of solid food (mashed bananas) to first steps and first lost teeth, every milestone was met with fanfare and the recognition that the child was moving onto something new. As my children have gotten older, I recognize that the “lasts” are significant too, but the problem is, we don’t know when the “lasts” happen until they have been gone for a while. None of my children sit on my lap anymore, but I couldn’t tell you exactly when was the last time for any of them. I suspect Jacob and Liam lost their lap time earlier, in deference to their two little sisters. And Jamilet, now 15, was always on the go and eager to catch up with her older siblings, so she likely climbed off for the final time somewhere around third or fourth grade, but I can’t be sure.
            When was the last time Liam pushed a car on the floor, making a drooly “rrrrrr” sound as he drove it across the rug? What was his final Lego creation, before he put the blocks away for good? When did Jacob choose to relegate his bear, Colors, to a basement closet, rather than the space next to him, in his bed? Liam is in college; Jacob is out of college—for them, these events happened a lifetime ago; the dates and times these chapters closed don’t matter. My sons are looking forward—ahead to the first apartment, the first real job. When they were little, though, I didn’t know a chapter was closing, and now I carry a touch of sadness. Looking through a family photo album, I saw Teenasia, age 6, dressed up in a fuzzy dragon costume. She used to wear that costume around the house all the time, not just for Halloween. And then she stopped. I’m not sure when that was, or why. But I wish I could give her a hug in her final day as a green dragon and thank her for the extreme cuteness of that period.
            My interest in these “lasts” of my children have made me think of my own “lasts” that I didn’t know about at the time. I was a teacher in my 20s, and when I said goodbye to my class of seventh graders, I thought I was just taking some time off for maternity leave. I ended up finding a new profession after having Liam, and never went back to teaching.
            The constant movement of life means we have many “lasts.” Sometimes we are aware of them—like when Bill and I recently said goodbye to a dear family friend as he was dying, but more often we are not. Seasons of life, like actual seasons, change gradually. We see the leaves changing color in autumn, we notice them falling, but rarely notice the final leaf. And maybe this is by design. Perhaps our brains protect us as they prevent our awareness of the thousands of “lasts” that join with the thousands of “firsts” to make up a child’s first 18 years.
Amid the loads of laundry, the projects at work, the supervision of homework and the constant shuttling between home, school and practice, parenting does not allow for much reflection time. We are so deep into the demands of the present that a perspective of the moment’s significance can be forced out of reach. And that can be a blessing, because if I knew it was Liam’s final Lego tower, I probably would have burst into tears, and that would not have served young Liam well at all. I may not have let go of my tiny dragon girl—and she needed me to let go, so she could get on with her childhood. I may have asked Jacob to harbor Colors for another night or forced Jamilet into one more storybook on my lap. Our obliviousness to the “lasts” is what allows our children to grow up. They change gradually, and we unknowingly support them, by not stopping their transformative moments.
Yes, we notice later. Later, we glimpse what is missing; a habit or an action that has been replaced. Our children grow outside of our line of sight, without our permission.
For this, I am thankful.  

Sunday, March 11, 2018

Trauma-informed care: Transformative love

            This past spring, Oprah Winfrey discussed childhood trauma and trauma-informed care on 60 Minutes.
“If you don’t fix the hole in the soul, the thing that is where the wounds started, you’re working at the wrong thing,” Oprah said in an interview with CBS This Morning, before the airing of the program. A five-part Milwaukee Journal Sentinel series on the epidemic of childhood trauma informed Oprah’s understanding. The series explored how the myriad of social problems facing Milwaukee—from unemployment to substance abuse to crime— all have their roots in unresolved trauma.  “The story was life-changing for me,” Winfrey said to CBS. “It is my hope that our story on trauma-informed care will not just be impactful but will also be revolutionary. It certainly has caused a revolution in my own life.”
It was about seven years ago that I first heard the term “trauma-informed care” applied to parenting foster or adoptive children who had survived neglect or abuse. I was on a walk with a friend who had three adopted children just a bit older than my two younger children, both adopted from foster care.  My friend had recently learned the trauma-informed approach from her oldest child’s therapist. As she spoke, I remember feeling like everything within me tilted toward clarity.
“Trauma-informed care is when you look at difficult behavior through a different lens,” she said. “It’s an internal perspective change on the part of the parent or teacher. Instead of thinking, ‘What’s wrong with you,’ you ask, ‘What’s happened to you?’”
            As we talked, my friend sprinkled bits of neuroscience over practical pieces of parenting advice. She explained that when a young child is in an unsafe situation, under extreme stress, the immune system and body’s stress response systems may not develop normally. “So even later, when a child is placed with a safe family or in a safe classroom, under ordinary levels of stress, their systems may automatically respond as if he or she is still under extreme stress,” she said.
While a child’s rush of adrenaline, pounding heart and fight, flight or freeze response are all life-preserving ways to face actual threats to safety, in the context of the normal stress of everyday life, this child will be perceived by others to be over-reactive, unresponsive or detached. Parents, teachers and coaches using techniques that may work well on non-traumatized children unwittingly trigger children of trauma, and what would normally be a simple moment of correction can escalate into a major behavioral incident as child’s fear response is triggered.
            At the heart of the approach is definitive research showing that adverse childhood experiences (ACES) such as parental mental health issues; parental separation or divorce; physical, emotional and sexual abuse; parental substance abuse and parental distance cause physiological changes in the brain and the body.
            The ACE Study found that the more types of childhood adversity a person experienced – the higher their risk of chronic disease, mental illness, violence, being a victim of violence and other consequences. On a scale of 10, just one out of three of us have an ACE score of zero, a childhood free of significant heartache. Twenty-six percent of people have one adverse childhood experience; 15% have two; and 22% have three or more. In neighborhoods with high levels of violence and crime, many children have an ACE score of seven or higher. Having an ACE score of four doubles the risk of heart disease and cancer. It increases the likelihood of becoming an alcoholic by 700 percent and risk of having serious difficulty performing a job by more than 300 percent.
            But the grim statistics are not without hope. Trauma has been part of the human condition since the beginning, and so have compassionate relationships—now proven to be the best healer of trauma. This healing approach to pain is not new; what is new is the language and research around it; techniques and data that allow more people to have visibility into what is required to fix the hole in the soul Oprah referenced. When researchers study people who have both high ACES scores and high levels of resilience, they find that these trauma survivors often have a story of a person who connected with them with understanding and compassion. It is this authentic compassion, over time, that provides healing. The research shows also that those who come in contact with vulnerable population groups can be trained to be compassionate responders. Homes, schools, youth programs, correctional facilities, and workforce training programs can be re-organized around trauma informed principles such as emotional safety, trustworthiness, collaboration and empowerment.
            For Christians, a trauma-informed response especially holds resonance. We can look to the Gospel to see how Jesus approached those around him. Trauma-informed care is all about healing through love. It’s the story of the prodigal son--  the father who welcomes his son even after poor decisions and separation. It’s the trauma-informed shepherd going after the lost sheep. It is Jesus first weeping, and then bringing Lazarus back from the dead. It is Jesus choosing not to chastise the woman at the well; and choosing to heal the ear of the soldier in the garden of Gethsemane. To be trauma-informed is to have the compassion of Jesus on the cross telling the repentant thief hanging next to him that before the day’s end, he’ll be with him in paradise. For caregivers, always at risk for compassion fatigue, we have the example of Jesus going off by himself to the mountain or the desert, to pray and regroup—and important tenant for gathering strength and patience.
Science has caught up with us, has determined a method to measure the power of hurt, but also of the power of love. Science has named our love “trauma-informed care.”  
Now we are called to go forth, to heal.

Tuesday, April 11, 2017

Family Vacations: Opportunities for connection and God’s grace

            My friend, Andrea Lemke-Rochon, is the youngest of five sisters whose ages span 17 years. This past spring, for the first time since she was an infant, Andrea spent a week with them—the five were invited by their aunt to be guests at her timeshare in the Bahamas.  While the setting was gorgeous and the weather was perfect, what was most significant for Andrea was the uninterrupted time the five had together.
            “We all agreed to unplug for the week, so we wouldn’t have distractions,” Andrea said. “We had no phones; we ate together; we sat on the beach and looked at the water; we spent time with each other. It was lovely.”
            While ads for vacation destinations may lead us to believe that the perfect vacation is all about choosing the right place, the truth is that the value of a vacation has less to do with the sights we see and more to do with the people we see those sights with. The root “vac” in “vacation” means “to empty.” At its core, a vacation is an opportunity for us to empty ourselves of our regular responsibilities. In their absence, we can better be present to those who we are vacationing with.
A vacation, done well, gives us the time and the space to connect more deeply with each other.  That connection can be completely non-verbal—a shared experience of jumping in the waves or flying down a rollercoaster drop. It can include learning something together—a history tour or museum visit.  And a good vacation doesn’t have to be one hundred percent cheerful fun; it can include an afternoon for an important, but difficult conversation. In planning a vacation, a more important question than “Where do we want to go?” is “How will we connect with each other?”
Connecting with Immediate Family:
            Soheil and Lisa, Badran, parents of three daughters, have noticed that their vacation stories hold a more solid place in family lore than other memories. “Whether it’s collecting sand dollars on the beach or finding that ice cream shop on a hot day, it’s the memories from vacations that always come up during family dinners,” Soheil said.
            Again, the idea of “emptying” plays its part in family vacation. As much as parents may need to escape work, kids need a break from the pressures of school, extra-curriculars and friendship drama.
            We went to a dude ranch in the middle of Colorado last summer,” said Emma Gillette, mother of three grade school kids. “No internet, no WiFi, no TV, no screens at all. It was amazing – it was a real ‘reset button’ for our family, and has made me reconsider what kind of vacations we'll take going forward.”
The Power of Extended Family:
            The advent of transportation and technology has led to more families scattering, with grandparents, aunts and uncles not as involved in a child’s day-to-day life.  Vacationing with extended family gives children the opportunity to become close to those they don’t see regularly. My uncle Mark, a father of five adult children, settled with his family in Nebraska in the 1970s, having grown up in Chicago and Milwaukee. Each summer, when I was young, the Scobey side of the family would get together at a reunion picnic in Chicago, at my aunt and uncle’s home on Crescent Lake, near Rhinelander, or at our family’s home in Whitefish Bay — this was the only time I saw my Nebraska cousins. “Through these trips, our kids gained an understanding the people who shaped my life over the years,” Uncle Mark explained. “It was a chance for them to see physical differences and similarities of relatives, and how locations where their relatives lived were similar to or different from their own home.”
Connecting with God’s Grace
            It is easier to feel the grace of God when we are present to the moment. For Andrea, who took the trip to the Bahamas with sisters, a moment of God’s grace was found in a jewelry shop with her oldest sister, Kathy, who had recently lost her husband.
            “It would have been Kathy and Ray’s fiftieth anniversary this year, and Kathy wanted to find a piece of jewelry to commemorate that,” Andrea said.
Kathy and Ray had spent their married life in the town of Aurora, Wisconsin, named after the Aurora Borealis, also known as the Northern Lights. “As Kathy browsed in the little jewelry shop, she found a beautiful ring and noticed that the line of jewelry was called Aurora Borealis, because the stones in the line had the same colors as the Northern lights. We just stood in the jewelry shop and cried together. God was in that moment.”
            As the first whiffs of warm weather hit, and Bill and I look toward the summer and plan time with our family, the wisdom of all these stories of the good vacations stay with us, reminding us we don’t need an exotic location or luxury accommodations. What we need is simply time away. Time for our family to “vacate” — to empty ourselves, so as to refill with love.

Wednesday, March 15, 2017

What's your ACE score?

Jesus’ ministry could be boiled down to two elements— teaching people
to love each other, and healing the sick through the love of God.
            Two thousand years later, science has caught up with Jesus.
In 1998, a seminal study by the Center for Disease Control established a strong causal connection between a lack of properly executed love from caregivers during childhood, and incidences of serious illness later in life.
The Adverse Childhood Experiences (ACEs) study, published in the Journal of Preventative Medicine, was conducted by giving a questionnaire about adverse childhood experiences to 17,000 mostly white, middle to upper-middle class people in San Diego. Various categories of adverse childhood experiences were studied: physical, sexual or psychological abuse; violence against the mother in the home; and living with household members who were substance abusers, mentally ill, suicidal, or ever imprisoned. Researchers found that more than half the respondents to the questionnaire had at least one childhood exposure to one of these seriously adverse experiences, and one-fourth reported two or more. When they studied the health of participants, they found that participants with higher ACEs scores had correspondingly higher incidences of chronic autoimmune illnesses, liver disease, alcoholism and depression.
Subsequent studies on adverse childhood experiences have corroborated the findings, showing that in addition, a higher ACEs score correlates to higher incidences of obesity, diabetes, stroke, some types of cancers and some types of heart disease. One a scale of one to ten, where each adverse childhood experience equals one point, having an ACEs score of four or more increases the risk of emphysema or chronic bronchitis by nearly 400 percent and suicide by 1200 percent. People with an ACEs score of six or higher are at risk for an average 20-year shortened lifespan. Higher ACEs scores also correspond with social problems --  higher rates of drug use, teen pregnancy, smoking, being a victim of rape and perpetuating domestic violence. Children with high ACEs scores are prone to rage and outbursts in school, often have trouble paying attention, get lower grades and are more likely to fail a grade and drop out.
Brain research is demonstrating what Jesus understood when he gave us the command to love-- that the experience of trauma (of being hurt, rather than loved) has a physical effect on the body. When children are traumatized, their bodies respond in a physical way, even into adulthood. Prolonged activation of the stress response systems disrupts the development of brain architecture and other organ systems, and increases the risk for both physical and mental illness.

With only a third of the US population having an ACEs score of zero, indicating no significant trauma, we can begin to understand that much of society’s troubles may have its roots in unhealed childhood trauma. Most people, regardless of ethnicity, religion or socio-economic status, carry an invisible cross of at least one or two significantly painful parts to their childhood. And 13% of people walk around with the toxic stress caused by four or more adverse childhood experiences.

            We are just 19 years out from the publication of the ACEs study—in the world of science, 19 years is a short time. It’s barely enough time to get the word out about the study’s results. But in the past 19 years, in response to the ACEs study, research has emerged on resilience. Children who have experienced adversity in childhood but who go on to develop resilience have better outcomes. How do we build resilience? The research points to one-on-one connections. When a person with a high ACEs score has a relationship with someone who offers him or her understanding and compassion, a bit of resilience is born. Those people with high ACEs scores whose parents struggle but who are fortunate enough to have strong one-on-one connections with teachers, healthy friends, relatives, coaches, mentors or pastors, fare the best.
            Jesus’ ministry of healing was all about one-on-one connections based on understanding and compassion. He sat with people; he touched them; he reacted with compassion and love for them. He even wept with love. And then he healed them.
            We are offered the same opportunity as Jesus to be healers. During our day, everyone we encounter (including ourselves) has an ACEs score ranging from 0 to 10 —everyone has a story of childhood. Every interaction we have with another is an opportunity to build that person’s resilience. Every action that includes understanding and a belief in the good of another can bring about healing. And that goes for showing compassion and understanding toward ourselves, as well. Those who have high ACEs scores, but who learn self-compassion, also build resilience.
Those around us who we find most challenging to love may have a reason for being so prickly-- childhood trauma can wrap itself in anger, as a form of protection. And when offered healing and compassion, these hurting folks may not find the wherewithal to respond with gratitude. When Jesus healed the 10 lepers, only one came back to say thanks.
            In the next decade, public health practices may shift in response to the ACEs study and what it predicts. Further study may crystalize best practices and techniques for doctors, mental health professionals, teachers and those in social service. We, as a society, may learn ways to foster large-scale resilience development; we may even discover opportunities to reach families early to lower ACEs scores from the beginning. But even as this happens, true resilience will still be built one person at a time, in moments when that person feels understood, loved and recognized.
            For us, as followers of Christ, the ACEs study and the follow-up research on resilience intensifies what we already know. Our call has always been to love and to heal. And now we have the data to prove why it’s important.